Modern Pediatrics. Ukraine

Enterosorption in the management of foodborne diseases: pathogenetic basis and clinical effectiveness of modern sorbents

О.S. Nyankovska — 2026-02-27

Foodborne diseases remain a significant global public health concern, contributing substantially to morbidity and mortality, particularly among young children, older adults, and immunocompromised individuals. Their pathogenesis involves both infectious injury and toxin-mediated intestinal and systemic effects. In addition to rehydration and etiotropic therapy, enterosorption represents a pathogenetically justified approach aimed at intraluminal detoxification through binding and elimination of pathogens, toxins, and metabolic byproducts from the gastrointestinal tract.

Aim - to analyze current scientific evidence on the efficacy, safety, and mechanisms of action of enterosorbents in food-related diseases and to determine the most suitable therapeutic option.

Modern enterosorbents are characterized by a large active surface area, high sorption capacity, and broad adsorption spectrum. Preparations based on highly dispersed silicon dioxide have attracted particular attention due to their pronounced protein-binding properties, ability to adsorb microbial cells and toxins, and potential antimicrobial and antidiarrheal effects. Clinical studies suggest that their inclusion in комплексive therapy of acute intestinal infections and functional gastrointestinal disorders, including pediatric practice, may contribute to faster symptom resolution and reduction of intoxication severity.

An important advantage of silicon dioxide–based enterosorbents is their favorable safety profile, as they are minimally absorbed from the gastrointestinal tract and are excreted unchanged. Further research is warranted to clarify clinical indications, optimize dosing regimens, and evaluate long-term therapeutic outcomes in different patient populations.

The authors have no conflicts of interest to declare.

Chronic constipation and incontinence in children with neurogenic bowel dysfunction: current management approaches (literature review)

K.T. Hlushko — 2026-02-27

Нейрогенна дисфункція кишечника (НДК) у дітей зі spina bifida або іншими захворюваннями спинного мозку є важливою клінічною проблемою, що суттєво впливає на якість життя, соціальну адаптацію та прогноз пацієнтів і потребує мультидисциплінарного підходу.

Мета - проаналізувати та узагальнити сучасні дані щодо патофізіології, клінічних проявів і підходів до ведення НДК у дітей.

Узагальнено сучасні уявлення про механізми формування НДК, зокрема, з порушенням іннервації товстої кишки, змінами моторики та чутливості, що призводять до хронічних закрепів і нетримання калу. Описано основні клінічні прояви залежно від рівня ураження нервової системи. Запропоновано етапний підхід до ведення пацієнтів, який передбачає модифікацію харчування і поведінкових звичок, використання фармакологічних засобів (осмотичних і стимулювальних проносних препаратів), застосування ректальних втручань (свічок, мікроклізм, трансанальної іригації), а також хірургічні методи в резистентних випадках. Окрему увагу приділено питанням безпеки та довготривалого застосування проносних засобів у дітей. Узагальнено сучасні клінічні рекомендації щодо ведення дітей із НДК, зокрема, рекомендації Spina Bifida Association та інших міжнародних організацій.

Висновки. НДК у дітей потребує індивідуалізованого, поетапного підходу з урахуванням віку, рівня неврологічного ураження та клінічних проявів. Раннє впровадження комплексних заходів, зокрема, поведінкових, медикаментозних і, за потреби, інвазивних, сприяє поліпшенню контролю симптомів і якості життя пацієнтів. Важливим є мультидисциплінарне ведення та дотримання сучасних клінічних рекомендацій.

Автори заявляють про відсутність конфлікту інтересів.

Current perspectives on hypertonic saline therapy in bronchial obstructive airway diseases

O.V. Sharikadze — 2026-02-27

Bronchial obstruction syndrome (BOS) is one of the most pressing clinical issues worldwide, particularly in paediatrics. It is associated with acute respiratory viral infections, obstructive bronchitis and allergic respiratory conditions, including bronchial asthma. This significantly worsens the quality of life of the child, increasing the risk of hospitalization and the need for emergency care.

Aim - to evaluate current approaches to the use of hypertonic saline solutions in the treatment of bronchial obstruction syndrome in children, with an emphasis on the effect on mucociliary clearance, clinical outcomes, and tolerability of therapy.

The pathogenesis of BOS includes excessive formation and increased viscosity of bronchial secretions, mucosal edema and bronchospasm, which leads to impaired mucociliary clearance (MCC) and worsens respiratory failure. In this regard, an important task of modern therapy is to restore MCC and eliminate excessive secretion. Hypertonic saline solutions (HSS) have proven their effectiveness in moisturizing the mucous membrane of the respiratory tract, reducing the viscosity of sputum and improving its discharge. Clinical studies have shown that the use of HSS in children with acute and chronic airway obstruction contributes to faster symptom relief, reduced need for bronchodilators and reduced duration of hospitalization. Of particular interest is the combination of HSS with hyaluronic acid (HA). Due to the anti-inflammatory and moisturizing properties of HA, such a combination (for example, LORDE® hyal) increases tolerance to inhalations, reduces the risk of bronchospasm and enhances the therapeutic effect. In children with acute bronchial obstruction, the use of HSS + HA already on the 3rd day provides clinical improvement, the appearance of productive cough and a reduction in the duration of the disease.

Conclusions. Inhalation therapy with HSS, especially in combination with HA, is an effective and safe method in the treatment of BOS. Further multicenter studies are needed to optimize the use regimens and evaluate long-term effects.

No conflict of interests was declared by the authors.

On the issue of diagnosing bronchiectasis in children - where do we stand now?

O.V. Mazulov — 2026-02-27

Aim - to review and analyze contemporary literature data regarding bronchiectasis in children, to increase physician awareness and to improve recognition of bronchiectasis in pediatric patients, and to formulate and establish the main diagnostic criteria for bronchiectasis.

We conducted a literature search in the PubMed and Cochrane scientometric databases over the last 10 years (since January 2014) using the search terms «bronchiectasis» or «suppurative lung disease», and «diagnosis» or «endotypes», or «phenotypes», or «biomarkers», and «children». It highlights that the prevalence of bronchiectasis is much higher, and the clinical spectrum of diseases causing its development is much broader than previously thought. High-resolution computed tomography of the chest serves as the gold standard for instrumental diagnosis of bronchiectasis in children, with the modern diagnostic criterion of broncho-arterial ratio in children differing from that used previously.

Patients with suspected or newly diagnosed bronchiectasis require a minimum panel of diagnostic examinations to delineate the primary cause of bronchiectasis and subsequently form an individual treatment and rehabilitation program.

The authors declare no conflict of interest.

Mycoplasma pneumonia in children: current aspects of diagnosis and treatment

S.O. Mokiya-Serbina — 2026-02-27

The article is devoted to the current problem of pediatrics and infectology - mycoplasma pneumonia. The disease occurs in children of different ages, but most often in the age category of 5-9 years, accounting for from 4% to 40% of cases of community-acquired pneumonia in children. The coexistence of Mycoplasma pneumoniae with other infectious agents - viruses and bacteria - is common. The last outbreak of mycoplasma infection in the world began at the end of 2023, the infection is characterized by a more severe course, affecting both adults and children. The incidence of macrolide-refractory mycoplasma pneumonia is increasing significantly, especially in East Asian countries.

Aim - to present the clinical and paraclinical features of pneumonia caused by Mycoplasma pneumoniae, based on the generalization of data from literary sources of scientific and research platforms Scopus, PubMed, Web of Science, Google Scholar.

The features of the course, approaches to the diagnosis and treatment of macrolide-refractory mycoplasma pneumonia, refractory mycoplasma pneumonia, corticosteroid-resistant mycoplasma pneumonia and pneumonia caused by mixed infection are considered. Treatment regimens are presented taking into account the pathogenesis of the disease, which is caused not only by the direct effect of the pathogen, but also by the immune response induced by it. When determining the recommendations, domestic clinical guidelines were taken into account.

Conclusions. The final decision on the diagnosis of mycoplasma pneumonia in children in each specific case should be based on the totality of anamnesis data, clinical signs and symptoms, and the results of auxiliary research methods, which with a high degree of probability can ensure the selection of optimal starting therapy, predict the course of the disease and resolve the issue of the need for hospitalization.

The authors declare no conflict of interest.

Diaphragmatic hernias in children

V.S. Konoplitskyi — 2026-02-27

Diaphragmatic hernias in children, both congenital and acquired, remain one of the most pressing problems in neonatal and pediatric surgery due to high morbidity, difficulty in diagnostic challenges, and significant mortality rates.

Aim - to analyze and systematize of modern scientific data on epidemiology, pathogenetic mechanisms, clinical and diagnostic characteristics, treatment methods and prognosis of both congenital and acquired diaphragmatic hernias in the pediatric population.

This work is based on a thorough systematic analysis of scientific literature published between 2015 and 2025, using major international electronic databases - Scopus, PubMed, Medline and Google Scholar, as well as national resources and registries. Diaphragmatic hernias in children constitute a significant challenge in pediatric surgery, characterized by a significant prevalence, difficulty in timely diagnosis and high mortality. Congenital and acquired forms of this pathology involve different developmental mechanisms, clinical manifestations and approaches to treatment, which necessitates a comprehensive and individualized approach that accounts for the anatomical and age-related characteristics of the diaphragm in children. In general, modern methods of diagnosis, intensive care and surgical techniques significantly reduce the risk of adverse outcomes in children with diaphragmatic hernias, and long-term interdisciplinary rehabilitation and medical supervision can substantially improve the quality of life of patients in the long term.

Conclusions. Modern prenatal and postnatal imaging techniques, such as ultrasound screening, computed tomography, and magnetic resonance imaging, have significantly improved early diagnosis, which is a key factor in selecting the optimal treatment strategy and determining the prognosis Surgical intervention remains the primary method for repairing diaphragmatic defects, while the use of modern surgical techniques, innovative materials for diaphragmatic reconstruction, and intensive postoperative therapy contribute to a lower incidence of complications and improved patient survival.

The authors declare no conflict of interest.

Social maturity of young men: developmental features

O.O. Chornyi — 2026-02-27

Аim - to conduct a theoretical analysis of scientific sources that reveal the features of the formation of social maturity of young men in the process of their development.

The relevance of the study is due to the need to substantiate the process of forming social maturity of young men as a holistic age period from 11 to 21 years. During adolescence, there are aspirations for self-expression and self-knowledge. The physical maturation of the body and the initial stage of socialization of the personality of young men are completed. The social maturity of young men depends on the characteristics of their development and physiological maturation, and the spiritual atmosphere of society. For the formation of social maturity of young men, the process of forming their personalities becomes important. Formation depends on the stages of choosing a profession, educational activities, adaptation processes. There is a need for knowledge for the formation of social maturity of young men. It is important to increase the competence of different groups of the population regarding behavior, development and mental processes in the adolescent period. Psychological education also increases the general culture of young men. Forms of psychological education - lectures, seminars, conversations, selection of literature. Educational institutions in which young people study need this type of activity of a practical psychologist. Adolescence as a transitional period from childhood to adulthood provides young people with the opportunity to actively experiment with models of their role behavior.

The formation of social maturity of young people and the features of their development also depends on the process of identity, psychosocial identity. This helps young people perceive their own personality in relationships with peers and adult surroundings, and determine acceptable forms of behavior in society. Pubertal transformations of an individual in adolescence are a holistic awareness of themselves and their place in the lives of other people and society.

The authors declare the absence of a conflict of interest.

Comparative analysis of oropharyngeal microbiocenosis in children with atopic dermatitis and bronchial asthma

L.A. Volyanska — 2026-02-27

It is difficult to overestimate the role of microbiota for human health. The microbiota affects the development of immune cells and immune responses, and the composition of the oral microbiota can contribute to sensitization and the development of additional reactions.

Aim - to qualitatively and qualitatively characterize the microflora of the oropharyngeal biotope in children with bronchial asthma (BA) and atopic dermatitis (AD).

Materials and methods. 11 people with AD and 15 children with partially controlled BA during the period of exacerbation of mild and moderate severity aged 9-17 years were examined. To assess the oropharyngeal biota, sputum culture was used on living media. The quantitative count of bacteria was expressed as the number of colonies of microorganisms in colony-forming units per gram (CFU/g).

Results. Children with AD were carriers of staphylococci: 54.54% α-hemolytic and 45.45% - β-hemolytic and S. aureus in 36.36%. In 80% of patients with asthma, α-hemolytic streptococci dominated in combination with a greater by weight. autochthonous microorganisms: Corynebacterium spp., Branhamella spp., Moraxella spp. Thus, staphylococci and hemolytic streptococci were constant for the biotopes of the oropharynx of children with AD and BA. The study groups differed in the composition of secondary microorganisms: in AD - Streptococcus spp. with β-hemolysis, E. coli, and Candida spp., in BA - representatives of the autochthonous microflora (Streptococcus spp. with β-hemolysis, Moraxella spp., Corynebacterium spp.). The variability of the species composition of the oropharynx biota in patients with AD was almost twice as high as the similar biota replaced with BA.

Conclusions. Determining the microbial associations of the oropharynx in patients with AD and BA, establishing their trigger role and the impact on the course of these diseases in children is a new direction in understanding the risk factors for the development of allergies and chronic inflammation, as well as possible therapeutic goals. In this pathology, staphylococci and α-hemolytic streptococci are determined to be constant for the oropharyngeal biotopes of children. The variability of the species composition of oropharyngeal biota in patients with AD was almost twice as high as that of patients with BA.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution. Informed parental consent was obtained for participation in the study.

The authors declare no conflict of interest.

Molecular genetics of neurodevelopmental disorders in Ukrainian children

Y.R. Grechanin — 2026-02-27

Neurodevelopmental disorders make a significant contribution to pediatric pathologies. This group of diseases varies symptomatically and has various underlying molecular reasons, which result in the necessity of personalized diagnostic and treatment protocols.

Aim - to detect metabolic pathways and molecular markers potentially contributing to the development of the pathological phenotype in pediatric patients with neural pathology.

Materials and methods. Selection of the patient’s cohort for the pilot study was done during consultations provided by pediatricians, geneticists, and neurologists following principles of an interdisciplinary approach in diagnostic and management of children with developmental abnormalities. Further analysis of detected DNA variations, along with structural and functional predictions, was done using the SNP-NEXUS tool.

Results. The work presented in this manuscript enabled the identification of all detected genomic variations that may be associated with the chosen clinical phenotype in the small cohort of patients. Further functional enrichment analysis allowed us to identify various biological cellular processes that may be affected by the identified genomic alterations. Particularly, we found metabolic pathways with high enrichment score for possibly pathogenic and probably pathogenic amino acid substitutions in proteins, with lipid metabolism having the highest enrichment score.

Conclusions. Predictive and functional enrichment analysis of SNV (Single Nucleotide Variation) patterns detected by DNA sequencing on a small cohort of pediatric patients with neurodevelopmental pathology allowed us to identify cellular processes and proteins that potentially play a role in neural pathology. Further investigation in a higher number of patients and search for statistically significant associations of the preselected targets with the phenotype may help to improve the diagnostic and treatment approach for the selected pathology.

The authors declare no conflict of interest.

Clinical characteristics of antitumor therapy complications in adolescents and young adults with lymphomas

Ya.T. Hula — 2026-02-27

Analysis of the structure and incidence of complications depending on the lymphoma subtype is essential for optimizing supportive care and individualizing therapeutic approaches.

Aim - to analyze the incidence, structure, and characteristics of infectious and non-infectious (toxic) complications of antitumor therapy in patients with different types of lymphomas.

Materials and methods. The study included 120 patients aged 14-40 with various histological types of lymphoma who received polychemotherapy according to internationally accepted protocols. The cohort comprised patients with Hodgkin lymphoma (n=54), B-cell non-Hodgkin lymphomas (n=36), T/T-NK-cell non-Hodgkin lymphomas (n=18), and lymphoblastic lymphomas (n=12). Complications were assessed throughout the entire period of active treatment. Non-infectious toxic complications were evaluated based on grade III–IV hematologic toxicity, gastrointestinal disorders, cardiotoxicity, and neurotoxicity.

Results. Infectious complications were registered in 37.5% of patients, with febrile neutropenia being the most common (20.8%). Its incidence was significantly higher in patients with T/T-NK-cell NHL and lymphoblastic lymphomas (33.3%) compared to Hodgkin lymphoma (13.0%) (p=0.015). Septic conditions occurred in 4.2% of cases. Non-infectious toxic complications were more frequent and varied according to lymphoma type: grade III-IV hematologic toxicity was observed in 32.5% of patients (up to 66.7% in lymphoblastic lymphomas; p=0.001), gastrointestinal disorders in 17.5%, cardiotoxicity in 10.0%, and neurotoxicity in 10.0%. The lowest complication rates were observed in Hodgkin lymphoma, while the highest were found in aggressive forms of NHL.

Conclusions. The incidence and structure of complications of antitumor therapy in lymphomas significantly depend on the histological subtype and treatment intensity. Patients with aggressive forms of NHL have a substantially higher risk of infectious and severe toxic complications, requiring enhanced monitoring, active prevention of febrile neutropenia, and individualized supportive care strategies.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed parental consent was obtained for participation in the study.

The authors declare no conflict of interest.

Progressive familial intrahepatic cholestasis in children: clinical features, diagnosis, and management

H.V. Kurylo — 2026-02-27

Progressive Familial Intrahepatic Cholestasis (PFIC) is a rare genetically determined liver disorder characterized by impaired bile secretion at the hepatocellular level and progressive cholestasis. The disease typically manifests in early childhood and leads to pruritus, jaundice, malabsorption, and growth retardation. Without timely treatment, it progresses to biliary cirrhosis, liver failure, and the need for liver transplantation.

Aim - to evaluate the clinical, biochemical, and psychophysical manifestations of PFIC in children, as well as the effectiveness of different treatment approaches.

Materials and methods. Seven children with PFIC (2019-2024) were observed and underwent comprehensive clinical, biochemical, and instrumental evaluation. Physical development was assessed using body mass index (BMI) and developmental quotient (DQ), while psycho-emotional status was evaluated using a modified Hamilton Anxiety Rating Scale. Pruritus intensity was assessed using the Visual Analog Scale (VAS). Treatment included conservative therapy, ileal bile acid transporter inhibitors (IBAT inhibitors), and surgical biliary diversion.

Results. All patients with PFIC1 and PFIC2 presented with jaundice and pruritus (VAS 6-10), whereas patients with PFIC3 had jaundice in 50% of cases and milder pruritus (VAS 5-7). Biochemical parameters indicated pronounced cholestasis. BMI and DQ demonstrated impaired physical and psychomotor development, particularly in PFIC2 cases. Conservative therapy improved biochemical parameters in 3 of 5 patients. IBAT inhibitors resulted in significant reduction of pruritus and improvement in quality of life in 2 children. Surgical intervention with subsequent liver transplantation restored liver function and resolved pruritus in 2 patients.

Conclusions. Genetic testing is the gold standard for the diagnosis of PFIC. Management of this condition should be performed in specialized multidisciplinary centers using pathogenetically targeted approaches, including IBAT inhibitors, ursodeoxycholic acid, surgical interventions, and liver transplantation in severe cases. Early diagnosis and comprehensive therapy can slow disease progression, improve quality of life, and delay the need for transplantation.

The author declares no conflict of interest.

Clinical and diagnostic features of bowel emptying disorders in children, taking into account proctogenic pain against the background of acquired pathology of the anal canal and rectum and their treatment

V.F. Rybalchenko — 2026-02-27

Aim - is to investigate bowel emptying disorders in children with acquired pathology of the anal canal and rectum, taking into account proctogenic pain, and to substantiate approaches to their comprehensive diagnosis and treatment.

Material and methods. The study included 286 sick children who had bowel emptying disorders against the background of acquired pathology of the anorectal region, which was established during the examination: proctitis in 51 (17.83%), hemorrhoids in 125 (43.71%), anal fissure in 67 (23.43%) and cryptitis in 43 (15.03%). There were 141 boys (49.30%), girls 145 (50.70%).

Results. The studies have established clear age-related characteristics of the incidence with a peak in the group of 4-9 years (28.67%). It was established that bowel emptying disorders in children are manifested by the formation of pathological stereotypes of defecation, in particular, defecation in a diaper (17.48%), feces smearing (15.38%) and defecation in uncomfortable conditions (13.64%), which indicates a significant influence of proctogenic pain. It is proven that proctogenic pain is the leading clinical syndrome and is observed in 85.32% of patients, with intense pain during defecation prevailing (44.75%), and unbearable pain for anal fissure (18.88%) and hidden pain (21.69%). It was found that children develop a negative attitude towards the examination: pronounced negativity towards the examination was noted in 27.27% of cases, towards discussion of constipation - in 20.27%, and smearing - in 13.64%, while adequate perception of the situation is observed only in 17.83% of patients.

Conclusions. Violations of bowel emptying are accompanied by the formation of pathological behavioral stereotypes: emptying into a diaper (17.48%), smearing (15.38%) and defecation in uncomfortable conditions (13.64%). Proctogenic pain is the leading syndrome (85.32%), with a predominance of intense pain (44.75%) and unbearable pain with anal fissure (18.88%), and together with a negative attitude to the examination (27.27%) and discussion of problems (20.27%) forms a vicious circle of “pain - fear - avoidance of defecation - progression of pathology”, which determines the need for a comprehensive approach to treatment. Conservative treatment methods had good results in 98.95%, and surgical treatment was performed in 1.05% patients with hemorrhoids.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patients was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Interrelationship between mental health and changes in stress-regulating systems in children and adolescents with type 1 diabetes mellitus during the war in Ukraine

D.A. Kashkalda — 2026-02-27

Aim - to investigate the relationships between indicators of stress-regulating systems depending on the mental state of children and adolescents with type 1 diabetes mellitus (T1DM) during the period of military actions in Ukraine.

Materials and methods. A total of 93 patients with T1DM (44 boys, 49 girls) aged 9-18 years were examined. Patients were stratified into three groups: 1 - normal mental health, 2 - non-pathological stress reactions, and 3 - mental disorders. Serum levels of cortisol (C), malondialdehyde (MDA), carbonylated proteins (CP), and superoxide dismutase activity (SODs) were measured. In whole blood, serotonin (S), glutathione peroxidase activity (GPx), and cellular superoxide dismutase activity (SODc) were assessed.

Results. Mental health status in adolescents with T1DM was associated with changes in stress-regulating systems, with sex-specific features. In patients with normal mental health, increased levels of C, S, MDA, SODs, and SODc were observed. Non-pathological stress reactions were characterized by elevated CP and reduced SODc and GPx activity. In adolescents with mental disorders, increased CP, decreased S, and reduced SODs and SODc activity were found. In girls, correlations in the first two groups reflected compensatory-adaptive mechanisms, whereas in those with mental disorders an imbalance between stress-regulating indicators was evident. In boys, even with normal mental health, findings suggested tension within the stress-limiting systems, progressing to exhaustion in groups with impaired mental state, alongside the accumulation of stress-realizing markers.

Conclusions. Stress-regulating systems are closely associated with mental health status in children and adolescents with T1DM during wartime. The imbalance between stress-limiting and stress-realizing systems is most pronounced in those with mental disorders, particularly in boys.

The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee. Informed consent was obtained.

No conflict of interest was declared by the authors.

Quality of life of a child with cerebral palsy: the role of parental competence in aspects of daily care and upbringing

O.V. Kyryk — 2026-02-27

Cerebral palsy (CP) is one of the most common causes of childhood disability in the world and in Ukraine. This disorder affects the child's posture, trunk control, and motor activity, which can lead to the development of secondary complications and disability. Developing parents' competencies in caring for and raising children with CP within the framework of early intervention (EI) helps reduce the risk of secondary disorders and increase the child's functional capabilities. An important role in this process is played by the EI service, which provides individualized support and rehabilitation of children from birth to four years.

Aim - to carry out a comparative analysis of the quality of life of children with CP depending on the level of parental competence in caring for and raising children with spastic CP aged 4 to 14 years.

Materials and methods. 105 children (aged 4-14 years) were studied, divided into two groups: group A (43 children who received the RP service); group B (62 children who did not receive specialized intervention). The level of quality of life was assessed using a CPQOL.

Results. Analysis of the results indicates that the higher the level of parental competence, the higher the level of quality of life according to the indicators of the sections: “Health”, “Family and friends”, “Participation”, “Communication”, “Access to services”, “Your health”.

Conclusions. The EI service an individual rehabilitation program focused on developing parents' competencies in caring for and raising children with CP has a positive impact on the quality of life of children, contributing to improved performance and functioning.

No conflict of interest was declared by the authors.

Sex and age morphometric parameters of metacarpal bones in preschool children

I.G. Biryuk — 2026-02-27

Radiographic examination of the skeletal system is a valuable tool for the comprehensive study of growth and maturation processes in the pediatric population. It allows for objective evaluation of age-related morphological changes, tracking skeletal development patterns, and early detection of developmental abnormalities or pathologies.

Aim - to determine the sex and age characteristics and morphometric parameters of the metacarpal bones of the right and left hands in children aged 4-7 years for further assessment of the harmony of the child's physical development.

Materials and methods. A study of the morphometric parameters of the metacarpal bones of the right and left hands was conducted based on a retrospective analysis of 179 radiographs of healthy children of both sexes aged 4-7 years.

Results. The study showed that the most pronounced elongation of the metacarpal bones occurred between the ages of 5 and 6, regardless of sex. In boys, the most intensive growth was observed in the first metacarpal bone of the right hand (+0.34 mm), the second (+0.37 mm), and the third (+0.37 mm). Among girls, even greater growth was found in some segments at the same age: the second metacarpal of the right hand increased by +0.64 mm (the highest value among all measured bones), the first by +0.35 mm, and the third by +0.21 mm. Between the ages of 6 and 7, growth rates declined, indicating the end of the active growth phase in preschool children. For example, the growth of the first metacarpal bone in girls during this period was only +0.07 mm, while in boys it reached +0.16 mm, indicating an earlier completion of the rapid growth phase in girls.

Conclusions. In children aged 4-7 years, typical growth patterns of the metacarpal bones of the hand were identified, with consideration of sex and bilateral differences. The most intensive bone growth occurred at 5-6 years, corresponding to the period of active somatic development. In girls, metacarpal bone growth begins earlier; however, after age 6, growth rates in boys become higher, indicating the emergence of sexual dimorphism in skeletal development. At ages 6-7, elongation rates markedly decrease, suggesting the end of the active hand growth phase in preschool children.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution specified in the study. Informed parental consent was obtained for participation in the study.

The author declares no conflict of interest.

Specificity of injuries in child pedestrians of different age categories due to motor vehicle trauma

Yu.Z. Kotsyubynska — 2026-02-27

Motor vehicle accidents involving child pedestrians remain one of the leading causes of trauma and mortality in the pediatric population. The specific mechanisms of injury formation in child pedestrians require detailed analysis considering age-related anatomical and physiological characteristics.

Aim - to determine the leading mechanisms of injury formation and age-specific patterns of bodily injuries in child pedestrians of different age groups resulting from contact with moving vehicles, in order to provide an evidence base for developing age-differentiated protocols for diagnosis, treatment, and prevention of motor vehicle trauma in the pediatric population.

Materials and methods. A retrospective analysis of forensic medical data, including photoroentgenograms and computed tomography results, was conducted in 87 children aged 2-18 years during 2014-2024. Four age groups were formed: group 1 (2-6 years, n=23), group 2 (7-9 years, n=18), group 3 (10-13 years, n=24), group 4 (14-18 years, n=22).

Results. Males predominated among the victims (63.2%). The highest mortality was recorded in group 4 (18.2%), and the lowest in group 2 (5.6%). The most frequent injuries were traumatic brain injuries (81.6%), lower extremity injuries (55.2%), and upper extremity injuries (54.0%). A statistically significant predominance of abdominal injuries was observed in the youngest children, and thoracic injuries in adolescents.

Conclusions. Statistically significant age-related injury patterns were established: children aged 2-6 years had an increased risk of abdominal injuries, children aged 7-13 years showed predominance of extremity injuries, adolescents aged 14-18 years had the highest mortality and thoracic injuries. These results provide an evidence base for developing age-specific protocols for diagnosis, treatment, and prevention of motor vehicle trauma in children.

The authors declare no conflict of interest.

Epileptic encephalopathies in inborn errors of metabolism in young children: focus on pyridoxine-dependent epilepsy

Yu.H. Antypkin — 2026-02-27

Inborn errors of metabolism (IEM) represent one of the most clinically significant yet underdiagnosed causes of epileptic encephalopathies in young children. The team of the Department of Pediatric Neurology at the State Institution "Ukrainian Center of Maternity and Childhood of the NAMS of Ukraine" has been investigating this problem for over 25 years, which served as the foundation for the preparation of this publication. Particular attention is warranted by pyridoxine-dependent epilepsy (PDE) — a rare autosomal recessive disorder caused by pathogenic variants in the ALDH7A1 gene — as a classical example of a treatable metabolic epileptic encephalopathy.

Aim - to systematize current evidence on epileptic encephalopathies in inborn errors of metabolism in young children, and to elucidate the underlying pathogenetic mechanisms, clinical features, and approaches to diagnosis and treatment.

A systematic review of the scientific literature was conducted using PubMed/MEDLINE and OMIM databases, with a focus on publications from the past 10 years.

A clinical case of a 3-month-old girl with neonatal epilepsy refractory to standard therapy is presented. The diagnostic workup included prolonged video-EEG monitoring, brain MRI, biochemical investigations, and next-generation sequencing (NGS) using the CarrierSeq panel (420 genes). Epileptic seizures associated with IEM are characteristically resistant to standard antiseizure medications and may present as status epilepticus at onset. Age of manifestation serves as a key diagnostic indicator: the neonatal period is most typical for pyridoxine-dependent epilepsy, urea cycle defects, and nonketotic hyperglycinemia, while infancy is more characteristic of GLUT1 deficiency, biotinidase deficiency, and peroxisomal disorders. The diagnostic algorithm encompasses three tiers: a basic biochemical panel (glucose, lactate, pyruvate, ammonia, blood gas analysis, plasma amino acids, urine organic acids, acylcarnitine profile), specialized metabolic tests (α-aminoadipic semialdehyde, pipecolic acid, cerebrospinal fluid pyridoxal phosphate level), and molecular genetic analysis. An empirical therapeutic trial with pyridoxine (30 mg/kg/day for 3 days) is indicated in all neonates with seizures of unknown etiology refractory to conventional therapy. In the presented case, two pathogenic variants in compound heterozygous state were identified in the ALDH7A1 gene, confirming the diagnosis of PDE. Targeted therapy comprising pyridoxine, arginine, folinic acid, and a lysine-restricted diet resulted in sustained seizure remission and normalization of psychomotor development.

Conclusions. Early identification and verification of a metabolic defect enables pathogenetically targeted treatment with the potential to fundamentally alter the disease prognosis. Nutritional and vitamin-micronutrient therapy represents an effective therapeutic approach for treatable forms of metabolic epilepsy, particularly in pyridoxine-dependent epilepsies.

The authors declare no conflict of interest.

Кawasaki disease in a 7-year-old boy mimicking a peritonsillar abscess

Y.S. Stepanovskyy — 2026-02-27

Aim - to analyze a clinical case of incomplete Kawasaki disease (KD) with atypical manifestations and to highlight the importance of early recognition in pediatric patients presenting with persistent fever unresponsive to antimicrobial therapy.

Clinical case. This report describes an atypical presentation of KD in a 7-year-old child manifesting as a presumed peritonsillar abscess, representing a rare otorhinolaryngological phenotype that significantly complicated the diagnostic process. A previously healthy boy was admitted with a 4-day history of high-grade fever, odynophagia, and painful cervical lymphadenopathy. Initial clinical assessment suggested a peritonsillar abscess; however, needle aspiration yielded no purulent discharge. Empirical antibiotic therapy failed to achieve clinical improvement. Magnetic resonance imaging excluded abscess formation and demonstrated inflammatory changes consistent with tonsillitis and cervical lymphadenopathy. By day 7 of illness, progressive thrombocytosis and bilateral non-exudative conjunctival injection were observed. Based on the constellation of clinical features (prolonged fever, mucocutaneous involvement, lymphadenopathy) and laboratory findings (elevated inflammatory markers, anemia, thrombocytosis), a diagnosis of incomplete KD was established in accordance with the American Heart Association guidelines. Treatment of intravenous immunoglobulin (IVIG) in combination with acetylsalicylic acid resulted in rapid defervescence and marked clinical improvement. Serial echocardiographic evaluations revealed no coronary artery abnormalities.

Conclusions. KD should be considered in the differential diagnosis of pediatric patients with fever lasting more than 5 days and presumed bacterial infections refractory to antibiotic therapy. Early recognition and timely initiation of IVIG therapy are critical for reducing the risk of coronary artery complications. Heightened awareness among clinicians, particularly in otorhinolaryngology and emergency settings, is essential.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.

The authors declare no conflict of interest.

A clinical case of polymorphism in migraine manifestations, its relationship and evolutionary connection with episodic syndromes that may be associated with migraine

L.V. Pypa — 2026-02-27

Migraine is a genetic brain disease with complex pathogenesis, polymorphic clinical manifestation and difficulty in diagnosing in children, as it may manifest itself in them not in classical variants, but in episodic syndromes - migraine phenotypes.

Aim - to inform the medical community about atypical clinical forms of migraine associated with episodic syndromes, for their timely diagnosis and, accordingly, rational therapy.

The article presents an analysis of a clinical case involving the development of migraine and related episodic syndromes. The peculiarity of this case lies in the ability to clearly trace, over the patient’s lifetime, the evolutionary stages of the development of migraine with aura, which was preceded by episodic syndromes potentially associated with migraine. The case illustrates the clinical polymorphism of migraine progression, the diagnostic challenges, and, as a consequence, the development of complications such as status migraineurs. The importance of timely diagnosis of such conditions in children and the prospects for further research are discussed.

Conclusions. Episodic syndromes in children included in ICHD-III, in particular, cyclic vomiting syndrome, abdominal migraine, may be the first stages of migraine development. The occurrence of individual episodic syndromes in a certain age range may indicate a certain evolutionary process of migraine development. The role of early preventive treatment of these episodic syndromes on their subsequent transformation into classic migraine with aura remains unstudied.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.

The authors declare no conflict of interest.

Identification of the main predictor of the success of treatment of congenital diaphragmatic hernia in newborns

V.S. Konoplitskyi — 2026-02-27

Congenital diaphragmatic hernia (CDH) in newborns is one of the most severe congenital anomalies with a high mortality rate. The diaphragmatic defect leads to the herniation of abdominal organs (stomach, intestines, spleen, liver) into the thoracic cavity, causing lung compression and profound dysfunction of the respiratory, cardiovascular, and digestive systems.

Aim - to establish a hierarchy of prognostic factors determining treatment success and survival rates in newborns with CDH.

A retrospective medical record review was conducted on 18 hospitalized newborns with CDH (10 males, 8 females) aged 0 to 21 days. The clinical course, instrumental findings, and the effectiveness of multidisciplinary treatment strategies were evaluated. Of the 18 patients, 12 underwent surgical repair (one postoperative death). Six infants died preoperatively due to severe refractory pulmonary hypertension (PH) and comorbidities. Clinical cases illustrate contrasting courses. A 21-day-old female with late manifestation and absent PH was rapidly stabilized and operated on. Conversely, a 1-day-old male with prenatally diagnosed CDH presented in critical condition due to severe PH and hypoxemia. He required massive pharmacological support and prolonged (72-hour) preoperative stabilization prior to type B CDH repair, followed by extended mechanical ventilation and parenteral nutrition.

Conclusions. PH severity often correlating with diaphragmatic defect size is the leading criterion determining optimal surgical timing and success; gestational age is not a decisive prognostic factor. Since standard PH therapies may fail, preoperative preparation duration must be highly individualized based on therapeutic response. Success fundamentally relies on a coordinated multidisciplinary team.

This study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children’s parents for the conduct of the study.

The authors declare no conflict of interest.

A case of bullous pemphigoid in a 4-month-old child

V.B. Semianchuk — 2026-02-27

Bullous pemphigoid is a rare autoimmune disease. The estimated incidence among children is approximately 0.2-0.5 cases per million per year. The disease is characterized by the formation of tense blisters filled with serous fluid, often accompanied by intense pruritus. The clinical course and localization of eruptions in infants and older children differ; however, a common feature is the involvement of the palms and soles in both age groups. The etiology remains unclear to date, but data suggest that such an atypical immune response may be triggered by non-specific maternal antibodies or foreign antigens. The cornerstone of treatment is the use of systemic corticosteroids with a gradual dose reduction.

Aim - to describe a clinical case of bullous pemphigoid with an emphasis on the diagnostic algorithm and treatment strategy.

Clinical case. A four-month-old patient was hospitalized with a rash characterized by multiple bullae on the palms, soles, and fingers, along with numerous papular elements on the trunk. Against the background of systemic corticosteroid therapy, a temporary improvement was observed during the first three days; however, new elements of the rash appeared a few days later. Following a diagnostic biopsy and direct immunofluorescence (DIF), the diagnosis of bullous pemphigoid was confirmed.

Conclusions. Bullous pemphigoid is a rare disease in the pediatric population. Nevertheless, delayed diagnosis and improper treatment strategies can lead to serious consequences. This case underscores the necessity of immunomorphological studies for definitive diagnosis.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the child’s parents for the study and publication of the data.

The authors declare no conflict of interest.

Neurodegeneration with brain iron accumulation associated with a WDR45 gene mutation as a cause of Lennox-Gastaut syndrome (a clinical case)

T.I. Stetsenko — 2026-02-27

Neurodegeneration with Brain Iron Accumulation (NBIA) comprises a group of rare inherited neurodegenerative disorders characterized by marked clinical and genetic heterogeneity, pathological iron deposition predominantly within the basal ganglia, and progressive involvement of the central nervous system. One of the NBIA subtypes is Beta-Propeller Protein-Associated Neurodegeneration (BPAN), caused by de novo mutations in the WDR45 gene (also known as WIPI4), located on the X chromosome.

Aim - to analyze the diagnostic features and significance of molecular genetic confirmation based on a clinical case of BPAN in a child with a pathogenic mutation of the WDR45 gene with an emphasis on the clinical course in the form of epileptic encephalopathy - Lennox-Gastaut syndrome.

Clinical case. A 6-year-old girl was evaluated. The patient presented with pharmacoresistant genetic epilepsy characterized by frequent tonic seizures and atypical absences consistent with Lennox-Gastaut syndrome, epileptic encephalopathy, cerebral palsy, and severe cognitive impairment. Brain magnetic resonance imaging revealed findings consistent with cerebral iron accumulation. Molecular genetic analysis identified a pathogenic mutation in the WDR45 gene, providing definitive confirmation of the BPAN diagnosis.

Conclusion. This clinical case highlights the diagnostic complexity of BPAN resulting from its genetic and phenotypic heterogeneity. Early identification of WDR45 mutations, together with integrated clinical, neuroimaging, and molecular genetic assessment within a multidisciplinary framework, is essential for timely diagnosis and optimal patient management.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the child's parents.

The authors declare no conflict of interest.